Systematic review, including meta-analyses, on the management of locally advanced pancreatic cancer

Systematic review, including meta-analyses, on the management of
locally advanced pancreatic cancer using radiation/combined modality
therapy
A Sultana, C Tudur Smith, D Cunningham, N Starling, D Tait, J P
Neoptolemos & P Ghaneh
British Journal of Cancer (2007) 96, 1183-1190.
doi:10.1038/sj.bjc.6603719 Published online 3 April 2007
<http://www.nature.com/bjc/journal/v96/n8/abs/6603719a.html>

"There is no consensus on the management of locally advanced
pancreatic cancer, with either chemotherapy or combined
modality approaches being employed (Maheshwari and Moser,
2005). No published meta-analysis (Fung et al, 2003; Banu et
al, 2005; Liang, 2005; Bria et al, 2006; Milella et al, 2006)
has included randomised controlled trials employing radiation
therapy. The aim of this systematic review was to compare the
following: (i) chemoradiation followed by chemotherapy
(combined modality therapy) vs best supportive care (ii)
radiotherapy vs chemoradiation (iii) radiotherapy vs combined
modality therapy (iv) chemotherapy vs combined modality therapy
(v) 5FU-based combined modality treatment vs another-agent-
based combined modality therapy. Relevant randomised controlled
trials were identified by searching databases, trial registers
and conference proceedings. The primary end point was overall
survival and secondary end points were progression-free
survival/time-to-progression, response rate and adverse events.
Survival data were summarised using hazard ratio (HR) and
response-rate/adverse-event data with relative risk. Eleven
trials involving 794 patients met the inclusion criteria.
Length of survival with chemoradiation was increased compared
with radiotherapy alone (two trials, 168 patients, HR 0.69; 95%
confidence interval (CI) 0.51-0.94), but chemoradiation
followed by chemotherapy did not lead to a survival advantage
over chemotherapy alone (two trials, 134 patients, HR 0.79; CI
0.32-1.95). Meta-analyses could not be performed for the other
comparisons. A survival benefit was demonstrated for
chemoradiation over radiotherapy alone. Chemoradiation followed
by chemotherapy did not demonstrate any survival advantage over
chemotherapy alone, but important clinical differences cannot
be ruled out due to the wide CI."


--
Matti Narkia
.